Doctor says Boy is too skinny (9 mo)

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Registered: 12-09-2008
Doctor says Boy is too skinny (9 mo)
2
Tue, 09-21-2010 - 5:37pm

I don't know if you remember me posting when Peter was a baby, but we eventually did make it almost all the way to exclusive nursing; but I'm not sure my supply was ever fully there.

Peter was fine at his 6 month checkup and had his nine month checkup today. They said he had fallen off the charts (off the curves for weight, was about 21% around 4 months).

I'm probably going to cram a lot in here but don't want to leave anything out...

His current weight at 9 months 10 days is 16.05. They weighed him when I came in and he was 16.03. They sent someone in to take another weight, and he'd been breastfeeding the whole time. 16.05 was the second weight--so obviously I'm producing something, and he's getting something. This was after not eating for about 4 hours. His height was in the 75th percentile--29 1/2 inches--so he's a long skinny guy. Honestly I'd kind of worried he was skinny but it makes me defensive when the doctor questions it... I can about count his ribs when he's naked but that's not what they commented on, just the placement on the graph. They want him back in a month for a weight check.

When his Daddy was little he was very skinny too, and there are tall people on both sides of our family--definitely a few tall skinny ones too. Daughter dropped on the curves her whole first year but they never noticed 'til I did and brought it up. She was breastfed 11 months, exclusively for 4. (Peter started solids at 4 months too; I wanted to go longer but it just wasn't working with him nursing all the time and a toddler sister).

At one point he was up to 3 big meals of solids but then for a while he hasn't seemed to need it. I feed him solids if either we are all eating and he can have some (it's been introduced), or if he seems hungry and my breasts don't seem very full. If I feel full I will generally nurse. Usually we only do one breast per feeding. It varies how many meals he gets, based on whether he is hungry.

Last week his cousins were visiting for a few days. One will be 3 in October; one will be two in October; my daughter is right in between them. He seemed to love the extra activity and didn't nurse as much; he did a little more self-feeding. We started the self-feeding only recently after finally figuring out how to get the high-chair tray to work, and I hadn't been spoonfeeding solids since then. Occasionally he will have 2 to 6 ounces of formula at night, especially if he wants to nurse all night long.

And he can nurse all night long. I think. He definitely usually wakes up around midnight, around 330, and around 530. Not sure if he stops when I'm not awake to put him back in bed and don't wake up to do it. But during the day, he has periods of happy playing where he doesn't want to eat. He will pull off and stop when he is done; he will not always take a bottle or solids. He does get full.

Sometimes oatmeal helps my breasts feel fuller.

I did give him Gerber tubs today at lunch time, while big sister napped. First tub peas (which he loves); second mixed veggies, which he doesn't love, but ate most of; third peaches, he wouldn't go for hardly at all; then I tried mixed fruit (banana/apple/pear) which he ate all of, and definitely wasn't as hungry by the end of. Then I nursed him, and he nodded off a few times, but not so much he'd stay asleep to go to bed. Took both sides. Eventually stopped to go get big sister up after around 2 hours of sleepy onandoff nursing. He wasn't too upset and is happy enough now that his playmate is up--though I think she might be feeding him cheerios... yup, she is. But he was mostly happy while I got her up and changed her, too, and wasn't eating then.

He has a posterior tongue tie, which was corrected around one month when he wasn't breastfeeding. He learned to breastfeed at 7 weeks and has loved it ever since. His tongue tie did grow back at some point. When I started solids it was because he was eating all the time--don't know if that was the tongue tie, my supply problems from when he was not eating, or a combination (I was not able to pump often enough to feed him exclusively breastmilk when he wasn't breastfeeding). I also have been diagnosed with PCOS. I've been on metformin in the past. We saw a lactation consultant a few times when he was having problems, and once more when I was having nipple pain, and she had recommended I try going back on it, but my doctor and Peter's doctor refused because I was breastfeeding. I don't trust my family practitioner group to know what's best for a breastfed baby; they said the growth charts they're using are "the only ones there are" and that solids at 4 months, 3 meals a day at 7 months was "right on target." But with all that's gone on I don't know if my mommy instincts are that much help either.

He has learned to crawl since his last doctor's visit, and is very active--crawls everywhere and pulls up on stools. His motor control is fine for his age (can self-feed cheerios); his vocalization is mostly just cooing or banging his head on my (or daddy's) chest or arm so it sounds like ba-ba-ba (or raspberries on skin).

His diapers have always been kinda borderline; my daughter's would be too. She always has access to water but just doesn't drink as much as some; I don't either, so I kinda think that's just a thing we have. Peter tends to have 4 or 5 wet diapers a day and poopy twice a day to every 3 days.

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Registered: 09-10-2009
Tue, 09-21-2010 - 9:41pm

Hi Jessi! I sure do remember you! Thanks for stopping back by! Would it be ok if we asked you a few questions? Certainly having an active baby and thinner parents are significant factors in having a thinner baby. I just want to see if there might be other things you can be doing to boost weight gain as well.



- How many times a day are you currently nursing?



- Can you give us a full weight history?



- How much solids is he getting in a day? Do you typically nurse before offering solids?

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Registered: 12-09-2008
Wed, 09-22-2010 - 10:23am

Okay, here goes:

"Certainly having an active baby and thinner parents are significant factors in having a thinner baby."
Well, his parents aren't skinny now, but DH was when he was little. Active, definitely yes. Also, forgot to mention he's probably teething--got his first tooth last week and I feel some more coming.

"- How many times a day are you currently nursing?"
Definitely at least the twice overnight, unless it's just all night long. Probably 3 to 6 times during the day, but I don't track it, and then in the evenings until he goes to sleep, which can be quite a while.

"- Can you give us a full weight history?"
Not really... the doctors office had been moving and haven't been giving me printouts. He had problems catching up at first, and got back to birth weight at 3 weeks. Yesterday they said around 4 months he was in the 21st percentile. I know around 6-7 months we were in a few times (for shots and an allergic reaction, which I think was to berries I had eaten), and he was 15 pounds and 3 or 5 ounces then.

"- How much solids is he getting in a day? Do you typically nurse before offering solids?"
I typically nurse before offering solids, I think. Three big meals was when he was eating the most--he's not doing that any more. It is so hard to figure out what to do without being able to see someone that I trust... He was having some sleep problems, and I tried cutting the solids, and that helped with the sleep a lot for one day and then he started seeming hungry again, and not sleeping as well, so I went back to giving him more food... Generally my pattern had been that when he seemed hungry, I nursed him, and if I'd nursed him on both sides within the past hour or so and don't feel full on either at all, that's when I'd give him solids. I had moved mostly to self-feeding, which he's been enjoying and doing fairly well at, before the appointment. In the evenings, if he's not settling down to sleep well, especially if he seems hungry (as opposed to just happy, awake, and not interested in nursing), we will sometimes feed him 2-6 ounces of formula. In the week before the appointment, I'd moved to just putting him in the high chair when the rest of us were having meals and giving him a little something. For instance, last night we were having hamburger helper, and he's not ready for that, so I gave him a banana (sliced up a bit at a time) while we ate. While his sister was having breakfast this morning, and I was making and having mine, he got a little bit (a tablespoon or two) of steak chopped up (because I was having it in my omelet) and when he finished that, because I was still eating, I gave him some puffed rice (maybe a quarter cup but he didn't eat even half of it). After that I breastfed him a bit, and when he stopped eating, I put him down (didn't offer second breast, but I don't think he would have taken it).

"A few of the things you've said are making me suspect that perhaps he's filling up on solids and not taking in enough breastmilk. We typically don't see babies moving onto 3 meals a day until 10-12 months."
At the time he was doing that, he was really seeming hungry to me--where he would nurse on both sides, give up, and still scream at me. And I'm not sure my production ever got quite up where it needed to be, especially for growth spurts.

"Also, when you described his lunch, am I understanding you correctly in that he ate 3 full jars of baby food for lunch before nursing? That's a huge enormous amount of food. Remember, breastmilk or formula really needs to be the primary source of nutrition until the 12 month mark."
That's not normally what I do, but after the doctor's appointment, I was just worried he might be hungry after all. He did nurse some before that, I certainly wasn't feeling full at that point, as well as nursing after.
I know that breast milk is best, but because of the rough start we got off to I am not sure I could trust my supply. The only reason I started solids at 4 months--I really wanted to wait until at least 6--was that I could tell he was hungry, and he was nursing all the time. I'm talking 10+ hours, and that would be one of the better days, and not counting overnight. And it made a big difference--he went back to being happy sometimes without nursing, and I could hold him or be near him without him crying for food.

"- I'm concerned that you're only nursing him if your breasts are feeling full. It's absolutely normal to not feel full anymore as baby gets bigger. I'm just concerned that if you're waiting long periods of time between feedings, you might be signaling your body to make less milk."
No, that's not what's happening--I think I explained poorly. I meant to say that I do not feed solids unless my breasts feel empty, not that I feed solids whenever my breasts feel empty. So if I felt like my breasts were even a little full, I wouldn't give solids, even if he hadn't had them yet--even if that meant some days he didn't get any solids at all. Before I moved to the self-feeding and meals at the same times as us, I was always breastfeeding first. But when his cousins were visiting, with three toddlers to feed, if it was a meal time I just sat everyone at the table and we'd all eat at once. For my survival and sanity. Although sometimes I'd nurse him at the table too. Before that, I always offered breastmilk first.

"- Why are you only nursing one breast per feeding if you have supply concerns? Do you offer the second side and he doesn't take it or do you not offer it? Can you begin offering it?"

I will try to begin offering it more. Generally he just does one side until he loses interest or falls asleep, and then I let him go off to play or put him to bed. If he wakes up he latches back on to the breast, and I generally don't delatch him. If he cries when I put him down I'll try the other breast, but usually that just means he wants to be held rather than exploring.

"- I'm floored that you had two doctors tell you you couldn't take Metformin while nursing. I just looked it up in Hale's book "Medication and Mother's Milk" (2010 edition) and Metformin is listed as an L1 (safest). That's the same level as taking a Tylenol. Is there any information I could send you that you could give your dr.'s? It kills me that you have a medical condition that you're not treating because of some blatantly incorrect information."
I really don't know what would help. I knew it was safe, I was on it during pregnancy to help maintain pregnancy until the second trimester. Mostly I wanted to be on it to help maintain pregnancy should I become pregnant, but even the endocrinologist was concerned about its effect on Peter's blood sugar. I suggested a trial period followed by drawing Peter's blood sugar to see if it was affecting him, but even that they did not like. So currently what I am doing is eating a very low carb diet--one of three things I did early in my pregnancy with Peter, along with metformin and (after a positive pregnancy test) progesterone. I believe that I have a history of very early miscarriage (one confirmed pregnancy that ended at 3 weeks, quite a few that I suspect which ended earlier), so I am testing every two weeks. My most recent test was on September 14 (negative). I have not had a period since February when Peter still wasn't really nursing, and I don't think I've ovulated, but I test to be sure I would know early if I did become pregnant. I was not on anything when Hannah was conceived, until I was diagnosed with gestational diabetes and needed insulin to control it (which happened with Peter as well).

"- You said "they said the growth charts they're using are "the only ones there are" and that solids at 4 months, 3 meals a day at 7 months was "right on target."

Wow. Wow. Wow. I don't know what to say about this. Obviously, you wouldn't have brought this up if you didn't already know this is off base. Are there any other options for dr's where you live? Here's some backup information for your own sanity."

I knew about the other growth charts, and mentioned them, but the doctor hadn't heard of them. I do not have a lot of options unless I purchase more expensive insurance. We are still trying to get the insurance company to cover our visits to the lactation consultant, which our doctor agreed was a good idea (when he would not nurse, and was losing weight, and was almost readmitted to the hospital for jaundice). I wish I could have worked with her more, but I don't have a car and she's an hour away, so we only met 4 times. It's just not feasible with DH at work.
I will definitely bring the growth charts to the weight check appointment.
I don't think they're breastfeeding-unfriendly on principle--my son's doctor has a son a bit younger than my daughter and breastfed him and even pumped at work--but yeah, they don't seem to know a lot of stuff.

"Sorry to bombard you with stuff. Let us know some more detail and we can definitely go from there. Hang in there, Jessi!!"

Thanks and no problem.

Since his appointment, here's what he'd done:
Nursed when we came home, at least twice before that big lunch, then after the big lunch nursed around 2 hours until his big sister woke up from her nap. Had dinner with us (1 banana... less whatever was covering him and the high chair). Kids got baths, Hannah went to bed, and then he nursed on and off from around 745 to 10 while daddy and I played on the wii and watched tv, waiting for him to fall asleep. He took both sides at least twice, but was seeming happy in between, just not sleepy, so I didn't give formula. Finally fell asleep and we put him to bed; then he woke up at 130, and I sat with him in my reclining chair and breastfed him. I woke up at 430, he was kind of asleep; I put him down and he cried a little, but Hannah had woken me up so I went and changed her diaper and he was asleep when I came back. He woke up again around 7, possibly because we made noise checking on him. I bumped his head changing his clothes so he breastfed a while to calm him down. We came downstairs and had breakfast (he had about 1-2 tablespoons finely chopped steak and 1-2 tablespoons puffed rice). After he got bored with the rice I fed him on the side he hadn't had after bumping his head, and then he went on the floor to play. While writing this he pooped, so I changed him and then nursed him a little again, but he wasn't interested for more than a few minutes. Offered the other side and he sucked less than a minute. He is now playing very happily with his big sister.

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Registered: 12-09-2008
Fri, 09-24-2010 - 6:16am
Did you have anymore thoughts? Should I be trying to feed more solids or formula or not?
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Registered: 10-27-2006
Sun, 09-26-2010 - 8:40pm

Hi Jessi!

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Registered: 04-13-2008
Tue, 09-28-2010 - 6:21am

One of the things that you seem concerned about is how your breasts feel. In the early stages of breastfeeding, your breasts can feel full and even get engorged.



But later on, your supply regulates to just what the baby needs, and it is quite normal not to be feeling full, unless you have gone longer than usual without nursing for some reason. You will be making milk, and even make milk on the spot during nursing - tust the process.



Frequent nursing sessions can be helpful for boosting supply if you are concerned. A few days just devoting yourself to offering often would be great. Sometimes, babies this age can get so active and busy playing that they don't ask to nurse as often as they could.



You have also been give good advice about solids that will help your baby grow.



Family history - eg other family members who have been thin babies - suggests you just have a thin baby. Is he otherwise active, mostly happy, healthyand alert when wakeful? That is a better guide.



As you will notice from the charts based on breastfed babies, it is more normal for babies to grow a lot slower in the second half of their first year. And even these charts are only averages. Not every baby will be parallel to the curves on them.



This link from Kellymom may help you, as well as some of the links at the bottom of the linked page.



http://www.kellymom.com/bf/supply/enoughmilk-older.html



Also this link to an article - Look at the Baby, not the Scale. One of my babies was born over the 97 percential, a big baby. Yet he is a reasonable sized young man now, not a giant. He too would have been described as slipping off the charts after six months.



http://drjaygordon.com/pediatricks/newborns/scales.html



All the best.



Teresa

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Registered: 12-09-2008
Thu, 09-30-2010 - 3:49pm

Making sure he gets solids seems to get the diaper count much more into the normal range. I think some of it has to do with my getting enough sleep, too.... if I manage to put Peter back to bed and sleep in bed, my supply seems higher.

Thanks for all the advice/sympathy.

I think for now I will be sticking with table food at dinner, and maybe lunch, plus one good feeding of solids a day ('cause he doesn't really eat too much self-feeding).

Last night Grandma watched him while we had Bible study for a few hours; he had about 1/4 cup of applesauce and NINE OUNCES of formula, and was still up twice in the night, so that part at least isn't just hunger. I've been trying to offer a lot but he's just not always interested.

He certainly is a happy camper right now--everyone always says he's so happy--but when he's hungry I can tell, he might be happy a little bit but when it comes to Mommy, he's only happy about being fed.

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Thu, 09-30-2010 - 4:14pm

It might also be worth noting that a longer torso and shorter limbs can run in the family, and some have commented on his long torso.

I guess I just wonder with the rough start, and I'm not sure my milk ever was enough... I know if I'd been just breastfeeding from the start I never would have worried. DD nursed 11 months and fell in the percentiles every visit, and the doctor never noticed until I pointed it out.

But as healthy as he is--alert, "talking", crawling, pulling up left and right, lets me know when he's hungry, very clearly knows where that milk comes from :)--he probably is fine. I had heard "look at the baby, not the scale" before.

He can still wear a lot of 0-3 month pants, waistwise, but they're all short; mostly for length he's in 6-9 mo or 12 mo.

I'll throw in a picture. This is him on Sept 24 and you can see he's skinny... and active.

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Registered: 04-13-2008
Thu, 09-30-2010 - 11:27pm

Did you look at the charts for breastfed babies? They give a better picture for the average of normal growth. Having said that, there will always be babies who rise in the percentiles and others who drop in the percentiles. All this means is that some babies grow a bit faster than average, and some babies grow a bit slower than average. It in itself does not mean that anything is worng, if everything else seems normal. There would be other signs if your baby was not well nourished, in terms of other developmental delays, lack of energy and so on.



When you are talking about falling in the percentiles on charts, all you are saying is that at the moment, his weight is not increasing at the same rate as the average baby. That's it. The charts based on formula fed babies undoubtedly actually lead us to think that the 'average' of continued high weight gain in the second six months of life is 'normal' whereas in fact it is not, and is likely to be because formula fed babies can drink too much, and this can lead to a higher rate of obesity later on. This is not the outcome you want.



A very active baby will often gain little weight, as they are using up lots of energy, and it sounds like your little boy is like that.



Does he have plenty of wet diapers?

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Registered: 12-09-2008
Wed, 10-06-2010 - 2:20pm

Sunday, DH and I went out for most of the day without the kids, and I think that threw things off for Peter.

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Registered: 08-01-2007
Sat, 10-09-2010 - 3:18pm

Google "banana baby". Dr. Sears coined the term to refer to BF babies that grow more in length than weight. He is critical of doctors who use weight as the primary indicater of growth when many BF babies focus on height. My son was like this, he grew 12 inches his first year, which is well above average. However, he was 18 lbs at a year, 22 at 2 yrs, and barely 25 at almost 3 years.